Visual Inspection Criteria

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The following are examples of visual inspection criteria. Individual hospital transfusion services must determine criteria as authorized by the medical director of the transfusion service.

Whole Blood (WB) & Red Blood Cells (RBC)

• The component must be in-date (not expired). Expiry date label must be present.
• At least one port must be intact.
• The red cell mass should not be discoloured (black or purple).
• There should be no observable large clots.
• The colour of red cell mass in the bag should be the same as the colour of red cell mass in segments.
• If visible, the plasma/supernatant should not be discoloured (not grayish, murky, purple or brown) or hemolyzed (bright red).
• The unit size and weight should be consistent with other units with the same anticoagulant (if unit appears smaller than others, check for visible supernatant).

Platelets & Plasma Components

• The component must be in-date (not expired). Expiry date label must be present.
• At least one port must be intact.
• The plasma should not be discoloured (grayish, murky, purple or brown) or hemolyzed (bright red)
• If the plasma is frozen, the bag should have no signs of breakage.

Fractionated Blood Products

• The product must be in-date (not expired).
• The contents should not be cloudy.
• Sterile cap cover(s) should be intact if the product is not pooled or reconstituted in the laboratory.
• The lot number on the vial or container should be identical to the lot number on the box/packaging. 

Further Reading

RBC Component Storage

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All components containing RBC (Whole Blood, LR, AS-3 RBC, LR, Red Blood Cells, LR, (CPDA-1 and CP2D) must be stored at 1- 6°C. Shelf life depends upon the anticoagulant/additive used.

See the table below for the shelf lives of common components in a closed system. In an open system, components stored at 1 - 6°C must be used within 24 hours.

Additional storage information may be found in the Circular of Information for the Use of Human Blood and Blood Components (Section C.7).

Time Limitations

Units must not be out of the controlled environment of the blood storage refrigerator for longer than 30 minutes to be eligible to be placed back into inventory.

This is required by all current standards and should be followed by all transfusion services and closely monitored by all personnel who handle or transport blood components. This standard and the shelf life are established to ensure the efficacy of the component and to prevent bacterial contamination of the component.

As well, transfusion should be completed within four hours of the time the component is removed from the controlled refrigerator.

Shelf Life

Specifications for Whole Blood and Blood Component Storage Devices

Blood component storage refrigerators are specially manufactured for this purpose. The following are requirements for refrigerators for whole blood and blood component storage:

• have a validated continuous recording device or be connected to one. If there is no continuous recording device, the temperature should be documented manually using a calibrated thermometer every four hours.
• have an audible alarm system with audible signal.
• be equipped with a fan and/or proper circulation to ensure constant temperature throughout the cabinet.

The CSA Standards for Blood and Blood Components (Z902-04) state that calibration of equipment must occur on a regular basis using an established procedure.

Canadian Society for Transfusion Medicine (CSTM) Standards requirements state that the alarm and back-up power supply for blood storage equipment must be checked at regular intervals and documented.

The most commonly used reference for a procedure for alarm calibration is the Technical Manual of the American Association of Blood Banks (AABB).

• This method uses calibrated thermometers, crushed ice for lower alarm calibration and warm water for upper alarm determination. In the procedure, the calibrated thermometer is placed with the temperature-sensing device to equilibrate.
• The thermometer and sensor are then placed in the water or ice mixture and the temperature of the calibrated thermometer read when the device alarms.

Examples of manufacturers of blood storage equipment (with specifications)

Laboratory Operating Requirements

1. The laboratory must have written procedures that contain directions for actions to take in the event of a power failure or malfunction.
2. Whole blood and components should be stored in a separate area from donor and patient specimens as well as reagents.
3. A secure area, segregated from available inventory, is required for autologous, donor-directed and other quarantined units.

Platelet Componet Storage

Platelet components must be stored at 20-24°C under continuous agitation. Their shelf-life is five days from the date of collection.

Platelet products, as a biological and with room temperature storage conditions, carry an increased risk of bacterial contamination because of their storage at room temperature. Transportation time should not exceed 24 hours.

Additional information on storage may be found in section D.7 of the Circular of Information for the Use of Human Blood and Blood Components.

Time Limitations

Health Care Facilities should have operating procedures in place that clearly define acceptable timeframes:

• for platelets to be in transit within the facility
• from the time platelets are released from the transfusion service until transfusion is complete

Specifications for Platelet Component Storage Devices

Platelet agitators and incubators for platelet component storage are required. If the agitator is not contained in a platelet incubator, the ambient temperature must be recorded manually every four hours as long as platelet components are stored, to ensure that a storage temperature of 20-24°C is maintained.

The laboratory must have written procedures that contain directions for actions to take in the event of a power failure or malfunction.

Examples of manufacturers of platelet agitators and incubators

When there is no Platelet Component Storage Agitator/Incubator in the Hospital Transfusion Service

Many small laboratories do not have a platelet agitator and/or incubator but occasionally must order platelets for transfusion. In these cases, a Standard Operating Procedure (SOP) that addresses this type of situation should be written. In the SOP, the following items should be included:

• The policy should state that platelets are not stored on site but, when needed for transfusion purposes, are issued immediately upon receipt from the blood supplier
• The communication mechanism with nursing to ensure that the component is used as soon as possible after receipt
• The policy and procedure should include steps to determine if the platelets have not agitated for more than 24 hours while in transit. If more than 24 hours have passed, the platelets should not be used for transfusion (or the medical director responsible for the transfusion service must authorize the issue of such platelets after determining the clinical need with the patient's physician)
• Record the ambient temperature manually when the product is received and every four hours until issue
• Documentation of the receipt and issue times as well as the authorization (who and when), if authorization was necessary
• Include visual inspection criteria for platelet components. When components are rarely used in a facility, it is important to provide criteria for technologists to use when handling the units.

Further Reading

Frozen Plasma and Cryoprecipitated AHF Component Storage

All frozen components must be stored in a controlled, monitored freezer. See the table below for shelf-life of common components in a closed system. When the system is "opened", components stored at 1-6C must be used within 24 hours. Additional information on storage may be found in the following sections of the Circular of Information for the Use of Human Blood and Blood Components:

• Frozen plasma, LR: Amendment 1
• FFP, LR and FFP, Apheresis: E.7
• Cryosupernatant Plasma,LR and Cryoprecipitated AHF, LR: F.7

Shelf Life

Specifications for Blood Component Storage Devices

Blood component storage freezers are specially manufactured for this purpose. The following are requirements for frozen blood component storage. Storage must:

• have or be connected to a validated continuous recording device. If there is not continuous recording device, the temperature should be documented manually using a calibrated thermometer every four hours.
• have an alarm system with an audible signal.

Examples of manufacturers of blood storage equipment (with specifications)

Laboratory Operating Requirements

The laboratory must have written procedures that contain directions for actions to take in the event of a power failure or malfunction.

Contingency Plan in Case of Malfunction

All laboratories should have written procedures that identify the steps to follow when critical equipment malfunctions. A Standard Operating Procedure (SOP) that addresses this type of situation should be written. The SOP should include steps for interim storage of blood components. These may include but are not limited to:

• Not opening the freezer when malfunction is found.
• Contact names for notification and for repair.
• Careful monitoring and documentation of temperature. When the temperature is close to the upper temperature limit, steps to remove the blood products for shipment to an alternate storage freezer.
• Use of blood component transport containers for shipment to nearby freezer or facility for storage.
• Monitoring of temperatures when an alternate freezer is located/used. If there is no continuous monitoring device on this freezer, the temperature must be read and documented every four hours.

Further Reading

Patient Identification for Pretransfusion Testing

Be Aware!
The most common cause of an acute intravascular hemolytic transfusion reaction is failure to identify the patient either during specimen collection or immediately prior to initiating transfusion.

Accurate patient identification is essential for safe transfusion practice.

In-patients

All in-patients must wear an identification band on their body. This is not always easy, especially for neonates and critically ill patients (such as burn patients) but it is essential to safe infusion and phlebotomy practices.

The information on the identification band must be compared to the information on the requisition prior to drawing blood for compatibility testing. If the information does not coincide, the specimen should not be collected until the discrepancy is resolved. In a STAT situation, there should be policies in place for the provision of uncrossmatched blood until accurate patient identification can be made. Some hospitals have policies in which phlebotomists carry unique identification bands for crossmatch purposes in these situations.

Out-patients

Out-patients should be banded for pretransfusion testing. Policies differ from hospital to hospital on how this is handled for pre-admission clinic patients
but many have a continuous identification process.

Unique Transfusion Identification Bands

Some hospitals use unique identification bands for all pretransfusion testing. These are sometimes referred to by the product names such as Typenex, Identiband (Hollister), Securline, I-Trac, etc.

If patients are given hospital identification wristbands these "unique" bands should not be required. Many hospitals use these for all patients rather than requiring phlebotomists to remember who should or should not be given a band, and laboratory personnel to know if the patient has or does not have an identification band.

If these unique bands are used, it is important that policies clearly state that the transfusionist must not depend solely on the unique number and must identify the patient using standard identification methods such as checking and spelling the patient's name and asking the patient to identify himself/herself.

However used, these bands are excellent for situations, which require STAT collection of blood specimens for pretransfusion testing, when the patient is not wearing any form of identification.

Specimen Labelling

The complete and accurate labelling of the specimen container(s) in the presence of the patient at the time of collection is essential to patient identification.

Historically, labels have been handwritten. With many hospital computer systems, the use of pre-printed labels has replaced the requirement for hand written labels.

Greater care must be used when labelling specimens with pre-printed labels to ensure that the correct patient's label has been attached to the specimen tube.

All specimens for pre-transfusion testing shall be labelled in that patient's presence with:

• Patient name - full legal last and first names
• ID number (health care number or other unique identifier for outpatients)
• Date of phlebotomy

The following information must also be documented:

• The name, initials or computer ID of the phlebotomist
• The date and time of collection

A final check of labelled specimens prior to leaving the patient's bedside should be performed. This final check is made by comparing all labelled specimens from the patient with the patient's identification band information.

Specimens received in the transfusion service that are insufficiently labelled or illegible must not be used for pretransfusion testing. Policies and procedures must be in place for actions to take when unsuitable specimens are received in the hospital transfusion service.

The importance of correct patient identification and labelling of specimens cannot be overstressed.

Rejection of Specimens

The following list includes, but is not limited to, examples of specimens that a hospital transfusion service should not accept for testing:

1. The specimen is not labelled with the minimum required information.
2. The specimen label is not legible.
3. The identity of the patient is in doubt.
4. The phlebotomist is not identified.
5. The specimen quantity is insufficient.
6. The specimen quality is unsuitable for testing (e.g., diluted with IV fluid, etc.).

ABO & Rh Testing

ABO Grouping

Correct and accurate ABO typing of a patient is arguably the most important test done in the hospital transfusion service. If done incorrectly or on an improperly identified specimen, the result could be the transfusion of incompatible red cells and consequent patient fatality.

The test for ABO must include both testing of the patient's red cells with anti-A and anti-B (forward group) and testing of the patient's plasma or serum with A1 and B cells (reverse group). For infants less than four months of age a reverse serum group should not be performed because ABO antibodies are not developed.

Any discrepancy must be resolved prior to the issue of group specific red cell products.Only group O red cells and AB plasma components should be released until the results of these tests are interpreted correctly.

Rh Typing

Rh testing is done by testing the patient's red cells with anti-D. Unless otherwise indicated by the manufacturer of the anti-D, a control system appropriate to the anti-D reagent must be used to avoid false positive results.

Testing for the weak D antigen is not required for pretransfusion purposes (although some transfusion services may choose to perform weak D testing).

A control must be tested according to manufacturer's directions. This may include a control on group AB Rh positive patients to ensure false positive results are not obtained when testing red cells that react with all three reagents (anti-A, anti-B, anti-D).

Test interpretation

The following table shows ABO/Rh test results with the expected blood group interpretation.

Antibody Detection & Crossmatch

The goal of antibody screening is to detect unexpected clinically significant red cell antibodies. In general, clinically significant antibodies are antibodies known to have caused Hemolytic Disease of the Newborn (HDN), hemolytic transfusion reaction, or shortened survival of transfused red blood cells.

There are several ways to detect red cell antibodies. Each hospital or region determines its method of antibody screening and compatibility testing. Regardless of the method or enhancement media used, the method must be capable of detecting clinically significant antibodies, which requires that the antibody screen method include a 37oC incubation with reagent red cells that have not been pooled followed by an Indirect Antiglobulin Test (IAT), or an alternate method that has documented capability to provide comparable sensitivity.

Methods of Antibody Detection & Crossmatch

1. Indirect Antiglobulin Test
   - LISS
   - PEG
2. MTS™ GEL Test (Gel-IAT)
3. Solid Phase Adherence Assay (SPAA)

Whenever the antibody screen is found to be positive, an antibody investigation must be performed.

Crossmatch Methods

1. Immediate Spin Crossmatch

   The Immediate Spin (IS) crossmatch is performed only after an antibody screen is done and found to be negative on a current specimen. The patient should have no history of clinically significant antibodies.

   The immediate spin crossmatch is meant to detect ABO incompatibility. It can also detect cold reactive (clinically insignificant) antibodies that react at room temperature (RT).

   If the patient's expected ABO antibodies are not reactive or weak at immediate spin,donor units should be ABO confirmed prior to testing with this method.

2. Computer or Electronic Crossmatch

 Further Reading

Antibody Investigation

An antibody investigation is performed to identify or confirm the presence of clinically significant red cell antibodies. In general, clinically significant antibodies are antibodies known to have caused Hemolytic Disease of the Newborn (HDN), hemolytic transfusion reaction, or shortened survival of transfused red blood cells.

Transfused patients may experience potentially life-threatening hemolytic transfusion reactions if clinically significant red cell antibodies are misidentified or unidentified.

Antibody identification is part of a larger workflow that typically includes:

• ABO and Rh Typing of patient
• Antibody Screening to detect unexpected patient antibodies
• Antibody Identification of patient antibodies
• Antigen Typing of patient's pretransfusion specimen
• Antigen Typing of donor red cells if patient antibody is clinically significant
• Crossmatching with antigen-negative donor red cells

Pre-analytic

Before beginning to identify antibodies, available patient information must be reviewed. Many factors can provide valuable insights to help resolve the problem:

• patient history (transfusion history; obstetrical history; diagnosis)
• patient demographics
• sample characteristics
• initial serologic results and characteristics

Analytic

Each hospital determines the method of antibody identification but usually the same method used for antibody screening and compatibility testing is used for identification.

After the patient’s plasma (or serum) has been tested with the initial panel (using the method of choice) and results have been read and recorded, and assuming there is one or more positive reactions, the antibodies present are identified using a “cross-out” (“rule out”) method. The result is often identification of a probable antibody with several antibodies requiring further exclusion and therefore requiring additional tests to eliminate.

Common Clinically Significant Antibodies
Rh	Kell	Kidd	Duffy	MNSs
anti-D	anti-K	anti- Jka	anti-Fya	anti-S
anti-C		anti- Jkb	anti Fyb	anti-s
anti-E
anti-c
anti-e

Post-analytic

To improve the quality of conclusions when identifying antibodies, a checklist is a simple tool to increase transfusion safety. 

Additional considerations

Some patients form multiple antibodies or antibodies to high frequency antigens making compatible (antigen-negative) RBC difficult to find. In such cases, CBS may be able to help find antigen-negative donors through its database of rare donors or by mass phenotyping of donors.

The “cross-out” (“rule out”) method

The cross-out method is used by some hospitals to identify which antibody(ies) is/are present in an unknown plasma or serum. The cross-out method is a tool to help identify both probable antibodies for which serologic evidence exists and possible (“not ruled out”) antibodies, which may require further testing to eliminate. The cross-out tool is only an aid to antibody identification.

It is used in combination with pre-analytic and post-analytic strategies to determine with the best possible probability which antibodies a patient has.

• Homozygous expression of the antigen that test negative with the unknown plasma or serum are crossed off with an "X" and heterozygous expression of the antigen that test negative are crossed off with a "/".
• When all reactions are assessed using this method, exclusion cells are chosen based on their homozygous expression for further testing.
• The goal is to rule out all clinically significant antibodies by at least one homozygous expression on a panel. If this is not possible, some hospitals use two (or even three) heterozygous expressions (the "/" and "\" form an "X:" on the panel antigram. See example below.

Exceptions

• An exception is the D antigen. Because the amount of D antigen varies according to Rh genotype (not necessarily related to homozygous or heterozygous expression of antigens), most laboratories exclude on the basis of a negative with any two D+ red cells.
• Some antigens do not show dosage (their inheritance is not based on two alleles) and can be excluded on the basis of a negative with a single red cell, e.g., f, P1, Lea and Leb.
• For rarer antigens, routine exclusion is not usually required unless an antibody directed against a low frequency antigen is suspected (i.e., a single cell positive for the rare antigen reacts and there are no other explanations for the positive result). Examples include Cw, V, Kpa , Jsa, Lua, Wra

Method

1. Using results from a panel (or screen), cross off the antigens showing negative reaction with the test plasma or serum.
   -Use an "X" when the antigen is expressed homozygously
   -Use a"/" or "\" when the antigen is expressed heterozygously. When two heterozygous cells are negative an "X" is formed.
2. When completed, review the antigram and look for antigens not "X’d” off.
3. Select additional cells to test that are homozygous for the antigen. Alternatively, if no homozygous expression is available, select two heterozygous cells.
4. If the patient is positive for the antigen and the direct antiglobulin test is negative the antigen can be excluded.

Example

The following are results obtained on an unknown plasma specimen. Note the difference in reaction in cells two and three.
This could indicate dosage where the antibody is reacting stronger with homozygous antigen expression on the test (panel) cells.

1. Starting with cell number one, antigens C, e, k, M, s, Fyb, Jka and Leb can be "X’d" off and these antibodies can be excluded. Since three D + red cells do not react, anti- D can also be excluded. Anti-P1 can probably be excluded on cell number one but ideally a strong expression of P1 antigen should be tested if available.
2.  Continue the same procedure with cell number four to exclude e (again), k (again), Fyb (again) N and Jkb by homozygousexpression. Cell number five has homozygous expression of c, N (again), S, Fyb (again), Jkb (again) and is Le(a+), and therefore excludes the corresponding antibodies.
   Note: cell number four has a heterozygous expression of the Ss antigens but since there are homozygous expressions thatshow negative results, the single "/" is not used.
3. The most probable antibody in this example is an anti- Fya but additional cells should be tested to exclude anti-E and anti-K.

D X

C X

E

c X

e X

K

k X

M X

N X

S X

s X

Fya

Fyb X

Jka X

Jkb X

Lea X

Leb X

P1 /

Test plasma IAT

1

R1R1

+

+

0

0

+

0

+

+

0

0

+

0

+

+

0

0

+

+

0

2

R2R2

+

0

+

+

0

0

+

0

+

+

0

+

0

+

+

+

0

0

2+

3

rr

0

0

0

+

+

+

+

+

+

0

+

+

+

0

+

0

+

+

1+

4

R1r

+

+

0

+

+

0

+

0

+

+

+

0

+

0

+

0

0

0

0

5

R2r

+

0

+

+

+

0

+

0

+

+

0

0

+

0

+

+

0

+w

0

As a quality control step when setting up additional cells always include a positive control with heterozygous expression of the antigen [in this case Fy(a+b+)] to the suspected antibody (in this case anti-Fya).

Emergency Transfusion

Attention

When emergency transfusion of uncrossmatched blood is required because of life-threatening situations, it is imperative that a system be in place for identification of unknown patients and to assure that correctly labelled specimens for crossmatch purposes are drawn prior to infusion of the uncrossmatched blood.

A recipient whose ABO group is unknown must receive group O Red Blood Cells. Rh negative RBC should be given preferentially to children and women of childbearing age.

This identification system usually consists of pre-registered identification numbers associated with fictitious names such as Unknown male A, Unknown female B, etc. In addition, some hospitals use unique identification bands for these situations. These are sometimes referred to by the product names such as Typenex, Identiband (Hollister), Securline, I-Trac, etc.

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

Once the patient's identity is known, identification banding, including the patient's correct name, a new hospital identification number, date of birth and other identifying information, is prepared and attached to the patient's wrist. At this time, a new crossmatch should be drawn using the correct patient information and sent to the hospital transfusion service. This enables the hospital transfusion service personnel to perform a history check and crossmatch as well as label additional units for transfusion. Only then should the "unknown" band be removed from the patient's wrist.

The Process must include:

• Records (lab and/or patient's medical record) should contain a signed statement of the requesting physician indicating that the clinical situation was sufficiently urgent to require release of the blood components prior to completion of compatibility testing. When possible, patient consent should be obtained. In most cases, this documentation will only be put in the chart after the patient is stabilized.
• If pre-transfusion testing cannot be completed prior to issue, a label must be placed on the unit that indicates that pre-transfusion testing had not been completed (i.e., uncrossmatched blood). If compatibility tests are completed and incompatibility is found, the physician responsible for ordering the blood must be contacted immediately according to written policies and procedures.

Plasma

All plasma components must be ABO-compatible, but not necessarily group-specific, with the recipient’s red blood cells.

In an Emergency

Always select group AB plasma when the patient's blood type cannot be determined on a current specimen.

Specimen Requirements

A specimen is generally not required when there is an existing ABO/Rh type on record for the patient. Some hospitals have policies that require an ABO/Rh typing on each new admission. Specimen collection is required when there is no current record of the patient's ABO type.

Rh Compatibility

• Plasma products may contain trace amounts of red blood cells therefore immunization to red blood cell antigens may occasionally occur if Rh negative recipients are transfused with Rh positive plasma components.
• When large volumes of plasma components from Rh positive donors are transfused to Rh negative females of child-bearing potential, prevention of D immunization by use of Rh immune globulin should be considered. This is defined by the medical director of the hospital transfusion service and is dependant upon the age and clinical condition of the recipient.

Plasma Component Compatibility Table

Platelets

Because platelet concentrates contain few red blood cells, compatibility tests prior to transfusion are not necessary. The donor plasma in platelets should be ABO-compatible (but not necessarily group-specific) with the recipient’s red blood cells, a requirement that is even more critical when transfusing neonatal recipients with a smaller blood volume.

Plasma Component Compatibility Table

Rh Compatibility

Immunization to red blood cell antigens may occur because of the presence of trace amounts of red blood cells in platelets. Because of this, when Rh-positive platelets are transfused to females of child-bearing age or younger, Rh immune globulin should be considered to prevent anti-D production.

Pre-transfusion Testing

The patient must be tested for ABO and Rh. The difficulty arises as to whether, once typed, patients require ABO and Rh typing on each admission. Because there are no standards that address this issue,policy typically is set by individual hospital or regional transfusion services.

Background Information

Patient ABO and Rh typing is required because, when possible, ABO-compatible and Rh-specific platelet concentrates are issued. When first tested, an antibody screen is normally done as patients requiring platelets may require red cell transfusions at some point.

Note: ABO-incompatible platelets would be acceptable for transfusion in life-threatening hemorrhage due to thrombocytopenia. A policy should exist in each facility detailing the circumstances and when authorization by appropriate medical personnel is required.

Cryo

Cryoprecipitate AHF (Cryo)

Compatibility testing prior to transfusion is not necessary for Cryo although some hospitals have policies that require a patient specimen be tested for ABO and Rh upon each new admission to hospital.

Cryo of any ABO group may be transfused to an adult recipient without harm because the amount of donor plasma in Cryoprecipitate AHF is minimal. ABO-compatible Cryo should be prepared for neonatal recipients.

Availability of Cryoprecipitate

Because of fewer indications for the use of this component (and consequently smaller productions volumes), group-specific Cryo is not always available.

Small hospitals may choose not to store Cryo of all ABO groups to avoid wastage due to outdating.

Criteria for re-issue for transfusion

Blood or blood components that have been returned to the transfusion service must not be re-issued unless the following criteria have been met:

1. The blood bag port(s) has not been opened.
    
2. They have not been issued longer than 30 minutes unless they were stored in a controlled blood storage environment.
    
3. Both the issue and re-issue are documented and the component has been inspected prior to re-issue;
    
4. At least one sealed segment of integral donor tubing remains attached to the original blood bag.

Storage of Blood Components: Further Reading

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. Brecker, M. E. Technical Manual, 14th ed. Bethesda, MD: AABB Press, 2002: 170-175, 180-182.
2. Canadian Blood Services, Circular of Information for the Use of Human Blood and Blood Components, 2002.
3. Canadian Standards Association, CSA-Z902-04, Blood and Blood Components, 2004.
4. Mollison, P.L., Engelfriet C.P., Contreras, M. Blood Transfusion in Clinical Medicine, 10th ed. Blackwell Science Ltd, Oxford, 1997: 290-300, 462-463.
5. Popovsky, M.A. ed. Transfusion Reactions, 2nd ed, Bethesda MD: AABB Press, 2001: 55-57, 147-148.
6. Petz, L.D., ed., Kleinman, S., ed., Swisher, S.N., ed., Spence, R.K., ed., Strauss, R.G. ed., Clinical Practice of Transfusion Medicine, 3rd ed. New York: Churchill Livingstone, Inc.: 1996.
7. Rossi, E.D., ed., Simon T.L., ed., Moss, G.S., ed., Gould, S.A., ed., Principles of Transfusion Medicine, 2nd ed. Baltimore, MD: Williams and Wilkins, 1996: 51-60, 245-256.
8. Tinmouth A, Chin-Yee I. The clinical consequences of the red cell storage lesion. Transfus Med Rev. 2001 Apr.;15(2):91-107.
9. Hyllner, M., Tylman M., Bengston J.P., Rydberg L., Bengtsson A. Complement Activation in prestorage leucocyte-filtered plasma. Transfus Med 2004. Feb; 14 (1): 45-52.
10. Blajchman M.A., Goldman M., Bueza F. Improving the bacteriological safety of platelet transfusions. Transfus Med Rev. 2004. Jan; 18 (1): 11-24.
11. Lockwood W.B., Hudgens R.W., Szymanski I.0., Teno R.A., Gray N.D., Effects of rejuvenation and frozen storage on 42-day-old AS-3 RBC’s. Transfusion. 2003. Nov; 43 (11) 1527-32.
12. Blajchman M.A., Goldman M. Bacterial contamination of Platelet Concentrates: Incidence, Significance and Prevention. Seminars in Hematology Vol 38, No. 4, Suppl 11 (October), 2001: 20-36.
13. Gulliksson H. Defining the optimal storage conditions for the long-term storage of platelets. Transfus Med Rev. 2003 Jul; 17 (3): 209-15.
14. Rock G., Maltzon C., Alhartoi A., Giulivi A., Palmer D., Bormanis J. Automated collection of blood components: their storage and transfusion. Transfus Med. 2003 Aug, 13 (4): 219-25.
15. Dumont L.J., VandenBroeke T., Seven-day storage of apheresis platelets: report of an in vitro study. Transfusion. 2003 Feb; 43 (2): 143-50.
16. Biedler A.E., Schneider S.O., Seyfert U., Rensing H., Grenner S., Girndt M., Bauer I., Bauer M. Impact of alloantigens and storage-associated factors on stimulated cytokine response in an in vitro model of blood transfusion. Anaethesiology. 2002 Nov, 97 (5): 1102-9.
17. Hunter S., Nixon J., Murphy S. The effect of the interruption of agitation on platelet quality during storage for transfusion. Transfusion. 2001 Jun; 41 (6): 809-14.
18. Hogman C.F. Storage of Blood Components. Curr Opin Hematol. 1999 Nov; (6): 427-31.
19. Vamvakas E.C., Carven J.H. Transfusion and postoperative pneumonia in coronary artery bypass graft surgery: effect of the length of storage of transfused red cells. Transfusion. 1999 Jul; 39 (&): 701-10.
20. Muylle L. The role of cytokines in blood transfusion reactions. Blood Rev. 1995 Jun; 9 (2): 77-83.

Specimen Collection: Further reading

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. American Association of Blood Banks, Guidelines for the Labeling of Specimens for Compatibility Testing, Bethesda, MD: AABB Press; 2002.
2. Callum JL, Kaplan HS, Merkley LL, Pinkerton PH, Rabin Fastman B, Romans RA, et al. Reporting of near-miss events for transfusion medicine: improving transfusion safety. Transfusion 2001 Oct.;41(10):1204-11. [ Full text ] [ Medline ]
3. CBBS e-Network Forum: Preventing pre-transfusion specimen labeling errors (Jan. 30, 2002)
4. Cummins D, Sharp S, Vartanian M, et al. The BSCH guideline on addressograph labels: experience at a cardiothoracic unit and findings of a telephone survey. Transfus Med 2000;10:117–20. [ Medline ]
5. Dzik WH, Murphy MF, Andreu G, Heddle N, Hogman C, Kekomaki R, Murphy S, Shimizu M, Smit-Sibinga CT; Biomedical Excellence for Safer Transfusion (BEST) Working Party of the International Society for Blood Transfusion. An international study of the performance of sample collection from patients. Vox Sang. 2003 Jul;85(1):40-7. [Medline]
6. Fact Sheet. Medical technologies are making blood supply safer than ever. Advanced medical technology Association (pdf file)
7. Goodman C, Chan S, Collins P, Haught R, Chen Y-J. Ensuring blood safety and availability in the US: technological advances, costs, and challenges to payment final report. Transfusion 2003. 43 (8): 3S
8. Lau FY, Wong R, Chui CH, et al. Improvement in transfusion safety using a specially designed transfusion wristband. Transfus Med 2000; 10:121–4. [ Medline ]
9. Linden JV. Errors in transfusion medicine. scope of the problem. Arch Pathol Lab Med 1999 ;123(7): 563–5.
10. Linden JV, Wagner K, Voytovich AE, Sheehan J. Transfusion errors in New York State: an analysis of 10 years' experience. Transfusion 2000;40(10):1207-13. [ Full text ] [ Medline ]
11. Lumadue JA, Boyd JS, Ness PM. Adherence to a strict specimen-labeling policy decreases the incidence of erroneous blood grouping of blood bank specimens. Transfusion 1997 Nov.-Dec.; 37(11-12):1169-72. [ Medline ]
12. McClelland DB, Phillips P. Errors in blood transfusion in Britain: survey of hospital haematology departments. BMJ. 1994 May 7;308(6938):1205-6.
13. Mercuriali F, Inghilleri G, Colotti MT, et al. Bedside transfusion errors: analysis of 2 years' use of a system to monitor and prevent transfusion errors. Vox Sang 1996;70:16–20. [ Medline ]
14. Myhre BA, McRuer D. Human error-a significant cause of transfusion mortality. Transfusion 2000 Jul.; 40(7):879-85. [ Full text ] [ Medline ]
15. Williamson LM, Lowe S, Love EM, Cohen H, Soldan K, McClelland DB, et al. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. Br Med J 1999; 319:16-9. [ Full text ]

Antibody detection methods: Further Reading

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

1. Bunker ML, Thomas CL, Geyer SJ. Optimizing pretransfusion antibody detection and identification: a parallel, blinded comparison of tube PEG, solid-phase, and automated methods. Transfusion 2001 May; 41(5):621-6. [ Full text ] [ Medline ]
2. Judd WJ. Modern approaches to pretransfusion testing. Immunohematol. 1999 Mar; 15(1): 41-51. [ Medline ]
3. Judd WJ, Barnes BA, Steiner EA, Oberman HA, Averill DB, Butch SH. The evaluation of a positive direct antiglobulin test (autocontrol) in pretransfusion testing revisited. Transfusion 1986 May-Jun; 26(3):220-4. [ Medline ]
4. Judd WJ, Fullen DR, Steiner EA, Davenport RD, Knafl PC. Revisiting the issue: can the reading for serologic reactivity following 37 degrees C incubation be omitted? Transfusion 1999 Mar; 39(3):295-9. [ Medline ]
5. Judd WJ, Steiner EA, Knafl PC. The gel test: sensitivity and specificity for unexpected antibodies to blood group antigens. Immunohematology 1997; 13:132-5. [ Medline ]
6. Sandler SG, Langeberg A, Avery N, Mintz PD. A fully automated blood typing system for hospital transfusion services. ABS2000 Study Group. Transfusion 2000 Feb; 40(2):201-7. [ Full text ] [ Medline ]

Compatibility testing (Crossmatch)

1. British Committee for Standards in Haematology. Guidelines for Pretransfusion Compatibility Procedures in Blood Transfusion Laboratories (pdf file). Transf Med 1996; 6: 273-83..
2. Butch SH, Oberman HA. The computer or electronic crossmatch. Transfus Med Rev. 1997 Oct; 11(4):256-64.
3. Chapman JF, Milkins C, Voak D. The computer crossmatch: a safe alternative to the serological crossmatch. Transfus Med 2000 Dec; 10(4):251-6. [ Medline ] [ Full Text ]
4. CBBS e-Forum. Experience with electronic crossmatch. California Blood Bank Society website (Aug. 2001)
5. Dietz G. Is the antiglobulin crossmatch a necessary part of the pretransfusion testing? Victoria Hospital. London, Ontario
6. Engelfreit CP, Reesink HW, Krusius T, Wendel S, Fontao-Wendel R, Hoffer I, et al. The use of the computer cross-match (International Forum). Vox Sang. 2001 Apr; 80(3):184-92.[
7. FDA. General Principles of Software Validation; Final Guidance for Industry and FDA Staff
8. Friedberg RC, Jones BA, Walsh MK; College of American Pathologists. Type and screen completion for scheduled surgical procedures. A College of American Pathologists Q-Probes study of 8941 type and screen tests in 108 institutions. Arch Pathol Lab Med. 2003 May; 127(5): 533-40. [ Medline ]
9. Judd WJ. Requirements for the electronic crossmatch. Vox Sang 1998; 74 Suppl 2:409-17. [ Medline ]
10. Novis DA, Friedberg RC, Renner SW, Meier FA, Walsh MK. Operating room blood delivery turnaround time: a College of American Pathologists Q-Probe Study of 12647 units of blood components in 466 institutions. Arch Pathol Lab Med. 2002 Aug; 126(8):909-14. [ Medline ]
11. Oberman HA. Developments in pretransfusion testing and compatibility testing. Transfusion. 2000 Feb; 40(2): 134. [ Medline ]
12. Shirey RS, Boyd JS, Parwani AV, Tanz WS, Ness PM, King KE. Prophylactic antigen-matched donor blood for patients with warm autoantibodies: an algorithm for transfusion management. Transfusion. 2002 Nov; 42(11): 1435-41. [ Medline ]
13. Shulman IA, Downes KA, Sazama K, Maffei LM. Pretransfusion compatibility testing for red blood cell administration. Curr Opin Hematol. 2001 Nov; 8(6): 397-404. [ Medline ]
14. Triulzi D J. Indirect and Direct Antiglobulin (Coombs) Testing and the Crossmatch. The Institute for Transfusion Medicine Update. October 2000.

Pretransfusion Testing - Platelets

1. Curtis BR, Edwards JT, Hessner MJ, Klein JP, Aster RH. Blood group A and B antigens are strongly expressed on platelets of some individuals. Blood 2000 Aug 15; 96(4):1574-81.
2. e-Network Forum. Rh immune globulin (RHIG) administration after transfusion of Rh-pos platelets/plateletpheresis units to Rh-neg recipients. California Blood Bank Society website. (Sept 2001)
3. Kickler T. Pretransfusion testing for platelet transfusions. Transfusion. 2000 Dec; 40(12): 1425-6. [ Medline ]
4. Larsson LG, Welsh VJ, Ladd DJ. Acute intravascular hemolysis secondary to out-of-group platelet transfusion. Transfusion 2000 Aug; 40(8):902-6. [ Full text ] [ Medline ]
5. Lin Y, Callum JL, Coovadia AS, Murphy PM. Transfusion of ABO-nonidentical platelets is not associated with adverse clinical outcomes in cardiovascular surgery patients. Transfusion 2002 Feb; 42(2):166-72. [Full text ] [ Medline ]
6. Mair B, Benson K. Evaluation of changes in hemoglobin levels associated with ABO-incompatible plasma in apheresis platelets. Transfusion 1998 Jan; 38(1):51-5. [Medline ]
7. McManigal S, Sims KL. Intravascular hemolysis secondary to ABO incompatible platelet products. An under recognized transfusion reaction. Am J Clin Pathol 1999 Feb; 111(2):202-6. [ Medline ]

Issue for Transfusion: Further Reading

Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.

Visual inspection

1. Brecher, M.E. ed. Technical Manual, 14th ed. Bethesda, MD; AABB Press; 2002: 182-185.
2. Kim DM, Brecher ME, Bland LA, Estes TJ, Carmen RA, Nelson EJ. Visual identification of bacterially contaminated cells. Transfusion. 1992 Mar-Apr: 32(3): 199-201. [Medline]
3. Roth VR, Arduino MJ, Nobiletti J, Holt SC, Carson LA, Wolf CF, et al. Transfusion-related sepsis due to Serratia liquefaciens in the United States. Transfusion 2000 Aug.;40(8):931-5. [ Full text ] [ Medline ]

Issuing

1. Haditsch M, Binder L, Bagriel C, Muller-Uri P, Watschinger R, Mittermayer H. Yersinia enterocolitica septicemia in autologous blood transfusion. Transfusion. 1994 Oct; 34(10): 907-9. [Medline]
2. Tipple MA, Bland LA, Murphy JJ, arduino MJ, Panlilio AL, Farmer JJ 3rd, Tourault MA, Macpherson CR, Menitove JE, Grindon AJ, et al. Sepsis associated with transfusion of red cells contaminated with Yersinia enterocolitica. Transfusion. 1990 Mar-Apr; 30(3): 193-5. [Medline]
3. Williamson LM, Lowe S, Love EM, Cohen H, Soldan K, McClelland DB, et al. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. Br Med J 1999;319:16-9.